Antimalarials

Question 1

DOC for Malaria

Answer 1

Chloroquine

Question 2

Guidelines for chloroquine resistant/unknown uncomplicated malaria or unkown species

Answer 2

1. Artesunate + atovoquone/proguanil
2. Artemether-lumefantrine
3. Quinine + doxy,tetra, or clindamycin
4. Artesunate +melfloquine
5. Artesunate+ sulfadoxine pyrimethamine

Question 3

Which ACT drugs are folate metabolism inhibtors

Answer 3

Proguanil
pyrimethamine-sulfadoxine
*best on erythrocytic forms

Question 4

chloroquine MOA

Answer 4

concentrates within the plasmodia in erythrocites. May interfere with lysosomal degredation of hemoglobin
res: tramsport pump out of cell

Question 5

Chlorquine kinetics and toxicity

Answer 5

-absorption inh by Mg/Ca (antacids)
accumulates in melanin rich tissues 
Liver metab CYP3A4!
Tox: Retinal/corneal toxicity
hemolysis- G6PD 
cannot give to pt with psoriasis or porphyria
long QT

Question 6

Artemisinins

+combinations

Answer 6

Artesunate and Artemether 
* for chlorquine res falciform and vivax*
1: Artesunate+ atovoquone-proguanil or Arthemether +lumefantrine 
2. Artesunate+mefloquine 
-last resort 
3. Artesunate- sulfa...
EMPERIC or PREG 
-not avail in US

Question 7

What other drug do you need to take with quinine and quinidine

Answer 7

doxy, tetra, clindamycin

- to reduce the length of treatment

Question 8

Side effects of quinine

Answer 8

Cinchonism- tinnitius, HA, dizzy,flushing, visual disturbance
QT elong
diarrhea
Hemolysis in G6PD def

Question 9

Antibiotics for malaria

Answer 9

Tetra,Doxy,Clinda- in addition to quinine for tx of complicated chlroquine resistant malaria in children or pregnant women
Doxy- prophylaxis against multidrug res malaria

Question 10

Mefloquine use and toxicity

Answer 10

Always combine with artesunate
- oral for chloroquine resistant erythrocytic strains
Tox: depression of myocardium (do no use with quinine)
siezures, aggravate latent psychoses( no for epilepsy/mental illness)
Vivid dreams

Question 11

Tissue Schizonticides

Answer 11

Primaquine
Tafeniquine
Radial cure for p. vivax and p. ovale
only work on exoerythrocytic forms